What helps against menopause symptoms like hot flushes and mood swings?
Hormone therapy works best against hot flushes and night sweats. Those who cannot or do not wish to use it can choose from proven non-hormonal medications and psychological therapy. Herbal supplements have no demonstrable effect.
Hormone therapy with oestrogen works best against hot flushes and night sweats. Several international guidelines confirm this. It works optimally if you are within ten years of your last period and have no contraindications, such as oestrogen-dependent tumours or certain cardiovascular problems.
Would you prefer not to use hormones, or are they not suitable for you? There are three non-hormonal medications with strong clinical evidence. Antidepressants such as paroxetine and venlafaxine demonstrably reduce hot flushes, but can cause nausea and reduced libido. Gabapentin also works, but causes dizziness in some people. Fezolinetant is newer and acts specifically on the brain mechanism behind hot flushes. It also appears to help with sleep and mood complaints, but there is still little long-term data. Oxybutynin, known as a medication for bladder cramps, also carries a recommendation, although the evidence is somewhat less strong.
Prefer no medication at all? Cognitive behavioural therapy and clinical hypnosis are the best-supported options for hot flushes, anxiety and sleep problems. With cognitive behavioural therapy, you learn to cope with your symptoms differently. Clinical hypnosis requires a specialist therapist, but performs well in solid research. Both are fully valid alternatives.
Diet and lifestyle help only to a limited extent. Omega-3 fatty acids and vitamin D have a modest positive effect on mood and anxiety, but the effects are small and the variation between studies is large. Weight loss helps with hot flushes and is also good for your heart and blood vessels. Exercise and strength training improve your physical and mental wellbeing, but have not been convincingly proven to reduce hot flushes themselves.
The 2023 NAMS guideline explicitly advises against herbal remedies and soy supplements: good to reasonable research shows insufficient effect. Yoga, mindfulness and acupuncture are likewise unproven for hot flushes. For controlled breathing, there is even strong evidence that it does not work. These techniques may improve your general wellbeing, but they do not resolve hot flushes.
Based on several international guidelines, including NAMS 2023, a meta-analysis of 32 studies on dietary interventions, and additional reviews. The effect of hormone therapy, antidepressants, gabapentin and fezolinetant is considered to be causally established. For lifestyle and dietary interventions, the evidence is largely observational or associative.
Which supplements genuinely help with menopause symptoms?
Soy isoflavones and phytoestrogens from red clover have the strongest support for menopause symptoms, particularly hot flushes. For vitamin D there is moderate evidence that it helps prevent bone fractures, which is especially relevant during and after menopause.
What complaints are most common during menopause?
The most common menopausal complaints are joint and muscle pain, fatigue and sleep problems; hot flushes are the most characteristic but do not top the prevalence rankings. If you recognise several of these complaints, it is worthwhile discussing them with your GP, who can consider what may help for each one.
Do black cohosh or red clover help with hot flushes during menopause?
Red clover may slightly reduce hot flushes; for black cohosh the evidence is contradictory. Both products may be an option if you want to avoid hormone therapy, but discuss it with your doctor, as the effects are small and study quality is moderate.
Does my weight and metabolism change during the menopause transition?
During the menopause transition, your body composition changes profoundly: more fat mass, less muscle and more dangerous abdominal fat. Your total weight on the scale may barely shift, yet something genuinely significant is taking place.
Can you delay menopause with lifestyle or diet?
Avoiding smoking, eating less red meat, and eating more citrus fruit and oily fish appear to have a favourable influence on the age of menopause. However, evidence from controlled experiments is still entirely lacking.
How do I know whether my mood swings are hormonal or something else?
The cyclical pattern of your symptoms is the best distinguishing factor: if they occur only in the two weeks before your period and disappear afterwards, a hormonal cause is most likely. Track your symptoms over several cycles, and if they persist outside that window, discuss this with your GP.